Provider Demographics
NPI:1780309922
Name:WIGGLESWORTH, CLAIRE RYAN (LAC)
Entity type:Individual
Prefix:
First Name:CLAIRE
Middle Name:RYAN
Last Name:WIGGLESWORTH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 W TODD ST APT 2
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-6269
Mailing Address - Country:US
Mailing Address - Phone:240-676-1371
Mailing Address - Fax:
Practice Address - Street 1:220 CONWAY ST UNIT 1
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-2706
Practice Address - Country:US
Practice Address - Phone:502-330-4233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-10
Last Update Date:2022-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2030171100000X
KYAC157171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist